Page 142 - Medicare Benefit Policy Manual

harnesses (including replacements) are also covered when these appliances are essential
to the effective use of the artificial limb.

Adjustments to an artificial limb or other appliance required by wear or by a change in
the patient’s condition are covered when ordered by a physician.

Adjustments, repairs and replacements are covered even when the item had been in use
before the user enrolled in Part B of the program so long as the device continues to be
medically required.

140 - Therapeutic Shoes for Individuals with Diabetes
(Rev. 241, Issued: 02-02-18, Effective: 04-01-18, Implementation: 04-02-18)

Coverage of therapeutic shoes (depth or custom-molded) along with inserts for
individuals with diabetes is available as of May 1, 1993. These diabetic shoes are
covered if the requirements as specified in this section concerning certification and
prescription are fulfilled. In addition, this benefit provides for a pair of diabetic shoes
even if only one foot suffers from diabetic foot disease. Each shoe is equally equipped so
that the affected limb, as well as the remaining limb, is protected. Claims for therapeutic
shoes for diabetics are processed by the Durable Medical Equipment Medicare
Administrative Contractors (DME MACs).

Therapeutic shoes for diabetics are not DME and are not considered DME nor orthotics,
but a separate category of coverage under Medicare Part B. (See §1861(s)(12) and
§1833(o) of the Act.)

A. Definitions

The following items may be covered under the diabetic shoe benefit:

1. Custom-Molded Shoes

Custom-molded shoes are shoes that:

• Are constructed over a positive model of the patient’s foot;

• Are made from leather or other suitable material of equal quality;